FDA Study Underestimates Impact of Graphic Tobacco Warning Labels

A controlled experimental study of over 5,300 smokers conducted by the University of Pennsylvania’s Annenberg Public Policy Center (APPC) posted to the FDA comment website shows that multiple versions of the proposed warnings produce desired effects by increasing negative feelings respondents experience about smoking a next cigarette.

“By failing to study the labels’ effects on affect, the FDA sponsored research missed a key factor that contributes to a commitment to give up smoking,” noted Dan Romer, director of the APPC’s Adolescent Communication Institute. “And they also underestimated the power of some of the proposed warning labels.”

The Annenberg study replicated findings from an earlier APPC study that identified the effects of Canadian cigarette pack labels on feelings about smoking (see Peters, Romer, Slovic, et al., Nicotine & Tobacco Research, 2007; 9:473-481).

Drawing on the content of the Canadian labels, the study also isolated ways in which the efficacy of the labels can be increased. For example, adding language saying, “Tobacco use during pregnancy increases the risk of preterm birth. Babies born preterm are at an increased risk of infant death, illness, and disability" increased the power of the label now proposed to say “ Smoking during pregnancy can harm children."

In their FDA posting, Annenberg researchers urged the FDA to study the individual components that contribute to the total message, a recommendation reinforced by the study’s finding that use of red lettering to communicate a warning increases the negative affect attached to smoking elicited by viewing the label. And the APPC researchers noted that some labels work with specific subpopulations more so than others. The picture of a baby in intensive care combined with the Canadian warning cited above only increased negative affect among younger (ages 18 to 24) smokers and smokers, irrespective of age, with children under five in their households, but did not have significant effects on other populations.

"Saying that additional research is needed is something of an academic cliché,” said Romer. “But the APPC experiments justify the conclusion that additional study is required to ensure that the labels are as effective as they can be at reducing smoking.”